Infectious Disease 7

What is the most likely finding on sigmoidoscopy in a patient with shigellosis?

Of the following, which is most likely to result in tetanus?

Which of the following findings in the cerebrospinal fluid is most consistent with suspected Rocky Mountain spotted fever (RMSF)?

A 25-year-old man comes to the office with left shoulder pain. He reports that, 1 week ago, he experienced pain in his fingers that has since diminished. He also has had a fairly persistent low-grade headache but has not had a measurable fever. His symptoms began a couple of weeks after returning from a summer vacation of hiking in Rhode Island. Examination discloses a dead, embedded tick in the posterior aspect of his right upper thigh. An enzyme-linked immunosorbent assay test on his serum comes back positive. Microscopic examination of his blood shows no abnormalities. Which etiologic agent is likely the cause of his problems?

The two currently available vaccines in the United States for healthcare personnel likely to be involved in response to a bioterrorism attack are smallpox and which of the following?

A 19-year-old male was seen at an urgent care facility and started on empiric clindamycin for an exudative pharyngitis with a history of penicillin allergy 7 days ago. He returns to the clinic with a complaint of numerous foul odored green liquid stools which contain large amounts of mucous in them, and lower abdominal cramping. Fecal leukocytes are positive and C. dif toxin is positive. Which of the following is the most appropriate treatment for this patient?

Which of the following immunizations is recommended for all HIV-positive adults and adolescents?

In early May, a 32-year-old man who has been hiking the Appalachian Trail on the south-to-north route presents to an Emergency Department in southwest Virginia with severe and debilitating headache, “aching all over,” fever, and chills. He seems unable to sit still, pacing around the cubicle or swinging his legs while sitting. A nurse complains that he “flew off the handle” at her when she asked him a simple question. Shortly after his arrival he begins vomiting. This history most strongly suggests which of the following?

A daycare center is experiencing an outbreak of giardiasis. Of the following medications, which is appropriate for treating the children?

Transient rose-colored spots on the upper abdomen that blanch on pressure and disappear within hours to days of acute illness are most consistent with a diagnosis which of the following?

What is the vector for malaria?

A 23-year-old female presents with a complaint of 2 days flu like symptoms consisting of fevers, sweats, headache and a diffuse macular rash. She is very concerned because two weeks ago she had unprotected sex with a male whom she later learned was HIV positive. She had a negative HIV screening test 3 months ago. You explain to her that these symptoms could represent acute antiretroviral syndrome and further testing is warranted. Which of the following tests would be most useful at this time?

A 23-year-old female presents to the clinic with severe fatigue, fever, myalagias, arthralgias and malaise. On examination she appears fatigued, has a pulse rate of 98 beats per minute and a temperature of 102.3o orally. There is postererior cervical, and axillary lymphadenopathy. On the abdominal examination there is right upper quadrant tenderness and splenomegaly. Laboratory results show leukocytosis with elevated lymphocytes, and elevated liver enzymes. Throat culture and heterophile antibody (monospot) are both negative. Which of the following organism is the most likely cause of this illness?

A 5-year-old female is brought to the clinic for evaluation of a rash. Her mother reports the child was previously well, but a few days ago was acting very tired, had a low grade fever, and the mother noticed that the child had some enlarged cervical lymph nodes. She noted the rash on the face the next day, which faded over the course of a day, then appeared on her trunk. Today the rash is on her extremities. On examination you observe a generally well child, but there is a fine, pink, maculopapular rash on the extremities, and patchy erythema on the oropharynx. You suspect that the child may have rubella and the mother is presently 6 months pregnant. Which of the following represents the most appropriate course of action?

A 23-year-old female with a history of HIV presents with a history of blurry vision and mild photophobia that has gradually developed over the past few weeks. On examination the conjunctiva appears normal, and the cornea is clear. Fundoscopic examination reveals neovascularization, and fluffy white pervascular exudates with areas of hemorrhage.   Which of the following organisms is the most likely cause of these findings?

A 4-year-old female is diagnosed with erythema infectiousum. Her mother is concerned because her older daughter is 15 and has never had this illness. If the older daughter does contract the illness, which of the following symptoms is she most likely to experience?

A 45-year-old female who is HIV positive comes in for a routine follow up appointment. Her latest lab results reveal that her CD4 count has fallen to 180 cells/c. Which of the following illnesses should she begin prophylaxis against at this time?

A 34-year-old male presents to the clinic for complaint of fever, myalgias and a rash all over his body for 3 days. He reports no significant past medical history but reports having travelled to Thailand approximately 3 months ago. On examination there are generalized maculopapular lesions, including on the palms and soles of the feet. There are also several nontender ulcerations of the oral mucosa that are silver colored with surrounding erythema. Which of the following lab tests should be performed on this patient?

A 27-year-old male is brought to the ER with a complaint of fever and rash. He has had flu like symptoms with severe headache and myalgias for one week. Two days ago he developed a rash that began on his wrists and ankles and then spread up his legs and arms to his trunk. He reports that he has just returned from a camping trip in Tennessee. On examination he is toxic appearing. He has a temperature of 103.4o orally, a pulse rate of 122 beats per minute and respirations of 22 breaths per minute. There are maculopapular and petechial skin lesions on his entire body, including the palms and soles of the feet. There are also few lesion on the hard palate. Which of the following is the most likely diagnosis?

A 27-year-old male with a history of HIV infection presents with a complaint of lesions on his tongue. On examination there are whitish lesions on the lateral aspects of the tongue, with vertical lines and “hairy” projections. Which of the following is the most likely underlying cause of this condition?

A 2-year-old African-American male with a history of sickle cell anemia is brought to the emergency department for a complaint of fever and refusing to bear weight on his left leg. There is no history of trauma. On examination he has a temperature of 103.4o orally, and is refusing to walk. His left knee is tender to palpation; however, there is no erythema or effusion noted. Laboratory studies show leukocytosis and elevated ESR and CRP. An x-ray is done and reveals nonspecific soft tissue swelling and localized periosteal elevation of the distal femur. Which of the following organisms is most likely the cause of this child’s condition?

A 38-year-old male presents for a complaint of a lesion on his penis for two days. He reports that it is not painful. On examination there is a 5 mm ulcerative lesion with indurated margins. There are also enlarged inguinal lymph nodes. The patient denies any drug allergies. Which of the following is the most appropriate treatment for this patient?

A 15-year-old exchange student who has arrived this week from Gambia is brought to the emergency room for a complaint of 3 days of intermittent high fevers which are precipitated by episodes of severe headache and fatigue. He then develops chills, which is followed by the fever, and then sweats. He feels well in between these episodes. On examination he has a fever of 103.0o and is mildly jaundiced, and moderate splenomegaly is noted. A CBC is done and shows anemia and thrombocytopenia. Which of the following blood tests would be most helpful in diagnosing this patient?

A 27-year-old female nurse presents for her annual ppd test that is required for work. When she returns for interpretation it is noted that she has 12 mm of induration at the site of inoculation. She has no symptoms of active tuberculosis and has a negative chest x-ray. She is started on a nine month course of isoniazid (INH). Which of the following medications should also be given with it to reduce toxicity?

A 48-year-old male presents to the emergency department for evaluation of diffuse watery diarrhea and mild abdominal cramping. He denies any blood or mucous in his stools. He has had no fever and no vomiting. He reports that he has just returned from a Caribbean cruise, and many of the people on the ship were sick with diarrhea as well. On examination he appears well, and is afebrile. His abdomen is soft and nontender to palpation. Stool examination is negative for blood or leukocytes. Which of the following is the most likely causative agent of his symptoms?

A 35-year-old female presents with a complaint of a mild, dry, cough since returning from a mission trip to South America six weeks ago. She has felt well otherwise, and denies fevers, chills, sweats, or weight loss. She was not concerned about the cough until this morning when she started coughing up what looks like worms. A CBC is done and shows a normal white count with mild eosinophilia. Which of the following is the most likely diagnosis?

A 3-year-old female is brought to the clinic for evaluation of nocturnal anal pruritus for three days. She is otherwise well. Her mother is instructed on how to perform the “scotch tape” test, which comes back with a positive result for ova. Which of the following treatments is the most appropriate for this patient?

A 6-year-old male is bitten by his neighbor’s dog. The dog’s rabies immunization status is unknown, but the dog is captured and deemed to be healthy by a veterinarian; therefore, rabies prophylaxis is deferred at this time. How long does the dog need to be observed before the decision to treat or not treat the child with rabies immunoglobulin?

A 32-year-old female presents for routine obstetric care late in her pregnancy. She did not find out that she was pregnant until she was 25 weeks gestation, and is concerned because she has 4 pet cats at home. She has many questions about the risk to the fetus. Which of the following conditions may affect the fetus as a result of Toxoplasmosis gondii infection?

A 58-year-old female with a history of bronchiecetasis presents with a 6 week history of progressively worsening productive cough, hemoptysis, night sweats and chills. Empiric treatment with levofloxacin has not been helpful. Her chest x-ray is unchanged from previous films, and routine sputum cultures do not grow out any pathogenic species. TB skin test is negative. Which of the following organisms is most likely the cause of her symptoms?